License Application - City Of Commerce City printable pdf download

CITY USE ONLY

CITY of COMMERCE CITY

License Number: ________________

5291 East 60

Avenue

Commerce City, CO 80022

Reporting Frequency: _____________

(303) 289-3628

Est. Liability: ________ SIC: _______

Please print clearly & check type of license requested.

Fee: $20.00 (non-refundable)

Retail License

Describe what you sell and/or services

(Retail sales in Commerce City)

Wholesale License

provided: _________________________

(Sales only to other licensed vendors for resale)

Consumer Use Tax License

_________________________________

(Required by all Commerce City-located businesses not engaged in making retail or wholesales sales)

Trade Name of Business (D/B/A): _____________________________________________________________________________

Taxpayer Name (owner, partner or corporate name): ______________________________________________________________

Location Address of Business: ________________________________________________________________________________

Mailing Address: ___________________________________________________________________________________________

Accounting Records Can Be Examined At: ______________________________________________________________________

Business Telephone Number: ____________________________ First Day of Business in Commerce City

: ___________

(MO/DAY/YR)

Number of Employees in Commerce City: _________ Estimate of annual taxable sales: __________________________________

Please indicate which filing frequency applies to you:

Monthly ( if tax is more than $50/month)

Quarterly (if tax is less than $50/month)

Yearly (if tax is less than $10/month)

Indicate Type of Ownership:

Individual

Partnership

Corporation

Limited Liability Company

Non-Profit 501 (C)(3)

(Please enclose copy of the IRS letter of exemption)

(1) Owner/Corporate Officers/Partners:______________________________________________________________

Title: ________________________ Social Security #

: ______________________________

(Federal Employer # if applicable)

Address

: ____________________________________________________________

(Residence or P.O. Box, Street, City, State, Zip)

Telephone Number: _________________________________ Birth Date: ________________________________

(2) Owner/Corporate Officers/Partners:______________________________________________________________

Title: ________________________ Social Security #

: ______________________________

(Federal Employer # if applicable)

Address

: ____________________________________________________________

(Residence or P.O. Box, Street, City, State, Zip)

Telephone Number: _________________________________ Birth Date:________________________________

If you acquired the business in whole or in part, complete the following:

Prior Owner’s Name:_____________________________________________

Date of Acquisition: ______________

Prior Owner’s Address: ___________________________________________________________________________

Purchase Price: $______________________________ Price of Personal Property

: $______________

(Fixtures & equipment)

I hereby certify under the penalty of perjury, the statements made herein are to the best of my knowledge true, correct and

complete.

Applicant’s Signature: ________________________________ Title:_______________________ Date: _______________

(Must be signed by Owner or Corporate Officer)

ALL APPLICATIONS MUST BE SIGNED AND INCLUDE THE $20.00 APPLICATION FEE (NON-REFUNDABLE)

License Application - City Of Commerce City

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